TTC_05_18_16_Vol.12-No.29.p1-16

The North Shore’s Largest Independent Community Newspa
May 18 - 24, 2016 www.TheTownCommon.com Page 13
Health & Wellness
By J. Peter St. Clair, DMD
Generally, people have
“insurance” to protect the most
important things in their lives.
Whether it is medical, dental,
car, life, disability, home owners
or trip insurance, most of us rely
on this coverage should we need
it.
We are quick to say, “What does
my insurance cover?” sometimes
before we even contemplate what
is in our best interest…..or, who
has our best interest in mind.
One thing is for sure – insurance
companies are looking to pay out
the minimum possible.
Patients will sometimes balk at
treatment not covered by their
dental insurance. Dentists will
often hear, “Just do what my
insurance covers. I don’t want
anything extra.” In fact, a recent
ADA poll showed that a lack of
dental insurance was the No. 1
reason most patients gave for not
visiting a dentist. So, here are just
a few frequent questions patients
often ask about dental insurance.
Why doesn’t my insurance
cover all of the costs for my
dental treatment?
I know you don’t really want
to hear it but - dental insurance
isn’t really “insurance” (defined
Brighter Smiles...
as a payment to cover the cost
of a loss) at all. It is a monetary
benefit, typically provided by an
employer, to help their employees
pay for routine dental treatment.
“Dental Insurance” is, always has
been, and always will be, only
designed to cover a portion of the
total cost.
But my plan says that my
exams and other procedures are
covered at 100%.
That 100 percent is usually
what the insurance carrier allows
as payment towards a procedure,
not what your dentist may
actually charge. Dentist’s fees are
usually a reflection of the level
and quality of care in a particular
office. Some cost more, some cost
less, depending on the costs of
running their office, how much
they pay their staff, the materials
they use, etc. An employer
usually selects a plan with a list of
payments that corresponds to its
desired premium cost per month.
Therefore, there may be a portion
not covered by your benefit plan,
depending on who you choose to
see.
Why is there an annual
maximum on what my plan
will pay?
Although most maximum
amounts have not changed in
30+ years, a maximum limit is
your insurance carrier’s way of
controlling payments. Dental
plans are different from medical
plans, in that dentistry is needed
Am I Covered?
frequently. Medical emergencies
are rare. It is your dentist’s
responsibility to recommend
what you need, not just what
your insurance covers.
If my insurance won’t pay for
this treatment, why should I
have it done?
It is a mistake to let your benefits
be your sole consideration when
you make decisions about dental
treatment. People who have lost
their teeth often say that they
would pay any amount of money
to get them back. Your smile,
facial attractiveness, ability to
chew and enjoy food, and general
sense of well-being are dependent
on your teeth.
Other than complaining to
The Town Comm
• Friendly/Personable Staff
978-948-8696 • www.thetowncommon.com • advertise@thetowncommo
your dental insurance company
Please call our office to
or your Employee Benefits
schedule a complimentary
Coordinator, your best defense
30 minute consultation.
is to budget for dental care, or
ask your dental office if they have
The
payment plans to spread payment
Town
151 Central Street, Rowley | 978-948-2030 | www.jpeterstclairdentistry.com
out over time.
If you have any other insurance
related questions please e-mail OMNI Security Team
them to me.
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Dr. St. Clair maintains a private
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dental practice in Rowley and
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view all previously written columns
at www.jpeterstclairdentistry.com/
blog.
Senior Scene
Where Are Medicare Hospital Ratings?
If you had been hoping to go
to the Centers for Medicare and
Medicaid Services website and
take a look at its new hospital
ratings, you’ll be disappointed.
It doesn’t exist yet. The very day
before the site was to launch, it
was delayed.
It seems that Congress, along
with the hospital industry, pushed
to stop the launch in its tracks.
For the survey, hospitals are rated
for more than 100 measures
of care, but the information is
often confusing. (Or perhaps
they’re afraid the information
will make them look bad.) For
example, hospitals objected to
a Medicare patient death rate
being known to women trying
to choose a hospital for having
a baby. Another objection was
that a hospital’s death rate might
be because the patients are low
income.
Hospitals called 60 senators and
more than 200 representatives
and asked for the delay so the
information can be reassembled.
We have ratings on CMS for
various patient surveys, and
those are of value. The higher
the number of stars, the lower
the death and readmission rates.
We have a star rating system for
nursing homes -- covering health
inspections, staffing, quality
measures and more. There’s one
for Home Health Compare that
includes a patient survey rating.
The new rating system for
overall hospital quality was meant
to make the information about
hospitals easier to understand,
with over 60 of the measurements
being condensed into the star
system, with ratings from one to
five stars.
Initially the CMS told
Congress that the website would
be running by July. Now they’ve
backtracked and say it might be
after July if they’re still working
on the data.
If you want to view the other
ratings, go online to cms.gov and
put ratings in the search box.
(c) 2016 King Features Synd., Inc.
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What do you
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